Pulse oximetry screening is a low-cost, non-invasive and painless bedside diagnostic test that can be completed by a technician in as little as 45 seconds to detect Critical Congenital Heart Defects (CCHD). Pulse oximetry testing is conducted to estimate the percentage of hemoglobin in the blood that is saturated with oxygen. When the screening identifies newborns with low blood oxygen concentration, additional testing can be completed to detect heart defects or other life-threatening conditions that could have gone undetected. Thirty percent of CCHD cases may not be identified by customary screenings.
Congenital heart defects are malformations of the heart or major blood vessels that occur before birth. It is the most common birth defect in the United States. In many cases, however, hospital staff may not identify these defects and outwardly healthy infants may be admitted to nurseries and discharged from hospitals before signs of disease are detected. Congenital heart defects account for 24% of infant deaths that are caused by birth defects. A quarter of infants who have congenital heart defects will be diagnosed with critical congenital heart disease (CCHD), a life threatening condition that requires surgery or catheter intervention within the first year of life. Failure to detect CCHD and late detection of CCHD may lead to serious morbidity or death. Fortunately, an emerging body of evidence suggests that measuring blood oxygen saturation can lead to early diagnosis and detection of CCHD.
The American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the American College of Cardiology Foundation (ACCF) recently outlined recommendations for a standardized pulse oximetry screening approach and diagnostic follow-up. According to these recommendations, screening should be performed on asymptomatic newborns after 24 hours of life in order to avoid false-positive results.
Pulse oximeters are available in most neonatal units, and hospital staff are well trained in how to perform pulse oximetry screening. The cost to hospitals to implement the screening program were minimal. A recent cost-effectiveness analysis estimated that universal newborn pulse oximetry screening would cost just under $4 per infant.
Although there are monetary costs associated with false positive results from pulse oximetry screening, these costs may be partially or fully offset by early diagnosis of infants with CCHD before they become ill and/or incur irreversible damage. Research suggests that the cost savings associated with early detection of a single case of CCHD could exceed the costs associated with screening 2,000 infants.